Ciprani Debora, Frampton Adam, Amar Hoda, Oppong Kofi, Pandanaboyana Sanjay, Aroori Somaiah
Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Department of HPB Surgery, Royal Surrey County NHS Foundation Trust, Guildford, UK.
Surg Endosc. 2023 Dec;37(12):9043-9051. doi: 10.1007/s00464-023-10518-8. Epub 2023 Oct 31.
The type and the extent of surgery is still debatable for intraductal papillary mucinous neoplasm (IPMN). Intraoperative pancreatoscopy (IOP) allows the visualization of the main pancreatic duct (MPD) in its entire length and could help determine the extent of MPD involvement and the type and extent of pancreatic resection. However, current guidelines do not advise its routine use as there is a lack of evidence supporting its safety and feasibility. The present study aims to perform a scoping review of published evidence on the safety and feasibility of IOP in IPMN surgical management.
We systematically searched PubMed, Cochrane, Medline and EMbase to identify studies reporting the use of IOP in IPMN surgical management. The research was completed in June 2023. Data extracted included patient selection criteria, demographics, safety of the procedure, intraoperative findings, impact on surgical strategy, histology results and postoperative outcomes.
Four retrospective and one prospective study were included in this scoping review. A total of 142 patients had IOP. The selection criteria for inclusion were heterogenous, with one out of five studies including branch duct (BD), main duct (MD) and mixed type IPMN. Indications for IOP and surgical resection were only reported in two studies. A median of seven outcomes (range 5-8) was described, including the type of surgical resection, additional lesions and change of surgical plan, and complications after IOP. IOP showed additional lesions in 48 patients (34%) and a change of surgical plan in 48(34%). No IOP-related complications were reported.
This scoping review suggests IOP is safe and identifies additional lesions impacting the surgical strategy for IPMN. However, the included studies were small and heterogeneous regarding IPMN definition and indications for surgery and IOP. There is a need for a large multi-centre prospective study to determine the role of IOP and its impact on surgical strategy for IPMN.
导管内乳头状黏液性肿瘤（IPMN）的手术类型和范围仍存在争议。术中胰管镜检查（IOP）可直视主胰管（MPD）全长，有助于确定MPD受累范围以及胰腺切除的类型和范围。然而，目前的指南不建议常规使用，因为缺乏支持其安全性和可行性的证据。本研究旨在对已发表的关于IOP在IPMN手术治疗中安全性和可行性的证据进行范围综述。
我们系统检索了PubMed、Cochrane、Medline和EMbase，以确定报告IOP在IPMN手术治疗中应用的研究。研究于2023年6月完成。提取的数据包括患者选择标准、人口统计学、手术安全性、术中发现、对手术策略的影响、组织学结果和术后结局。
本范围综述纳入了四项回顾性研究和一项前瞻性研究。共有142例患者接受了IOP。纳入标准各异，五项研究中有一项纳入了分支导管（BD）、主胰管（MD）和混合型IPMN。仅两项研究报告了IOP和手术切除的指征。描述的结局中位数为7项（范围5 - 8），包括手术切除类型、额外病变、手术计划改变以及IOP后的并发症。IOP显示48例患者（34%）有额外病变，48例（34%）手术计划改变。未报告与IOP相关的并发症。
本范围综述表明IOP是安全的，并能发现影响IPMN手术策略的额外病变。然而，纳入的研究规模较小，在IPMN定义以及手术和IOP指征方面存在异质性。需要进行大型多中心前瞻性研究来确定IOP的作用及其对IPMN手术策略的影响。
